Provider Demographics
NPI:1376818070
Name:SPECTRUM ORTHOTICS AND PROSTHETICS, INC
Entity Type:Organization
Organization Name:SPECTRUM ORTHOTICS AND PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-734-2435
Mailing Address - Street 1:2170 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2224
Mailing Address - Country:US
Mailing Address - Phone:530-892-1017
Mailing Address - Fax:530-892-1055
Practice Address - Street 1:2275 MYERS ST STE C
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5319
Practice Address - Country:US
Practice Address - Phone:530-538-9500
Practice Address - Fax:530-538-9400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO DEV AMERICA CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-13
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000251Medicaid
5763090001Medicare PIN